Clinical News

Guidance on Decontamination of Equipment for Gastrointestinal Endoscopy: 2014 Edition

Thursday, 10 July 2014 13:57

The Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee

June 2014

The 2008 guidance has been updated so as to incorporate the following developments:

  • The English Department of Health "Choice Frameworks for Local Policies and Procedures (CFPPs)" and equivalent documents from the devolved administrations.
  • Implications arising from moving decontamination facilities out of endoscopy units to centralised facilities, in some cases outside of the hospital campus; in particular the need to ensure a moist environment for endoscopes following last patient use and before decontamination, and conversely the maintenance of a dry storage state following decontamination and before next patient use.
  • Review of vCJD transmission risks, given that at the time of writing there are no known examples of vCJD arising as a result of endoscopy or surgery; guidance on decontamination of endoscopes following the performance of procedures in at-risk individuals is discussed, and quarantining of endoscopes is now deemed rarely necessary.
  • Some references to newer technologies such as NOTES and cholangioscopy.
  • A move away from enzymatic detergents, which have been linked to occupational dermatitis and asthma.
  • The introduction of audit tools, workforce recommendations and educational frameworks.

It is also acknowledged that there are many "stakeholders" in the field of decontamination. This, together with varying guidance from the devolved administrations, has frequently led to inconsistencies and misunderstandings. Against this background BSG Council has agreed that BSG will no longer co-ordinate revisions of its guidance, but a member of BSG Endoscopy will represent the Society on the Professional Expert Organisation Forum that has been established under the auspices of the Institute of Decontamination Sciences.

Finally Miles Allison would like to acknowledge the help and support of so many colleagues during his 12 years of involvement in this arena, in particular Tina Bradley, Helen Griffiths, Libby Thomson, Geoff Ridgway, Mike Bramble and the late Prof Don Jeffries.

Vacancies on NICE Quality Standards Advisory Committees (QSAC)

Tuesday, 08 July 2014 10:07

NICE is currently recruiting for additional members to join their Quality Standards Advisory Committees (QSAC) to support delivery of the library of quality standards topics.

NICE's quality standards are central to supporting the Government's vision for a health and social care system focussed on delivering the best possible outcomes for people who use services. Derived from NICE guidance and other accredited sources, they are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. The standards are also used to develop indicators for potential inclusion within the Clinical Commissioning Groups Outcome Indicator Set (CCGOIS) and Quality and Outcomes Framework (QOF) for general practice.

ERCP – The Way Forward, A Standards Framework

Mark Wilkinson, (BSG Endoscopy, working party convenor and chairman) et al.

June 2014

Executive Summary:

To improve the quality and availability of ERCP in the UK, a working party was set up incorporating a number of stakeholders (Appendix 3) to make recommendations to achieve this goal. The attached framework document is the output of that process. It is recognised that not all changes can be achieved immediately, but that these are the standards to be aimed for. Though regulatory frameworks differ among the 4 nations of the UK (and delegates from Scotland, Wales and Ireland were represented on the working party) it is intended that this framework will be applicable to the whole of the UK.

In brief its recommendations are:

  1. ERCP should only be carried out in facilities dedicated to high standards of performance and safety, as measured by key performance indicators.
  2. That there should be a minimum of 75 cases per annum for ERCP endoscopists, and 150 cases minimum per facility, although we should be aiming for a minimum of 100 cases and 200 cases respectively.
  3. That ERCP services should work collaboratively in a regional or hub-and-spoke model, with simple and rapid referral pathways established.
  4. That facilities for urgent or emergency ERCP should be widely available.
  5. That minimum standards for independent practitioners should be based on intention to treat and include a >=85% cannulation rate of virgin papillae, CBD stone clearance for >=75% of those undergoing 1st ever ERCP, and for patients with an extra-hepatic stricture, successful stenting with cytology or histology where appropriate at 1st ERCP in >=80%.
  6. That performance criteria should be monitored by a detailed audit and feedback process via a strengthened JAG/GRS process, and be incorporated into consultant appraisal.
  7. That the organisation and standards for training for ERCP should follow from the above performance criteria.
  8. That newly appointed consultants are mentored to ensure a safe and effective transition from trainee to independent practitioner.
  9. That high quality performance in ERCP service and training should support high quality research.
  10. There should be a national registry of ERCP cases to monitor practice and outcomes which will aid a cycle of continuous improvement and provide research data to plan better care in the future.

AUGIB Publication

Wednesday, 16 April 2014 15:02

In recent years a key area of concern for the BSG has been the lack of 24/7 provision of Acute Upper GI Bleeding (AUGIB) services. With a mortality rate of 10% and no notable improvement on this rate for years, the lack of out-of-hours coverage of services for AUGIB services is a challenge which must be urgently addressed.

Over the past year, the BSG has worked closely with NHSIQ to help identify areas which do not have AUGIB services available at all times, as well as how we can support gastroenterologists across the country to improve the availability of these services. Together we have produced a report which provides an overview of this project. Click here to read the report.

The survey, which is at the heart of this report, found that 23% of endoscopy units in England do not have AUGIB services that offer endoscopy patients 24/7 if required, and that 44% of units do not offer all acute admissions an endoscopy within 24 hours of admission with a GI bleed. You will note that the BSG, with support from NHS IQ, held workshops on this issue earlier this year.

The BSG will continue to campaign on this important issue and work with members and other bodies to promote improved provision of 24/7 AUGIB services.

If you would like support from the BSG around improving 24/7 access to AUGIB services in your Trust please contact the Chief Executive, This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

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